广东省韶关市2000例孕产妇梅毒检测情况分析

目的:了解韶关市孕产妇感染梅毒的现况。方法:收集韶关市各级医疗单位进行产前保健及分娩的全部孕产妇资料,进行分析。结果:2000例孕产妇中,梅毒检出率为0.79%;各年龄组孕产妇梅毒检出率经统计学分析有显著性差异(2=8.56,P=0.014);已、未婚孕产妇梅毒检出率经统计学分析有显著性差异(2=11.4,P=0.0007);各职业孕产妇梅毒检出率经统计学分析无著性差异(2=7.88,P=0.343);孕周≤28周与>28周、首次与多次(≥2次)妊娠的孕产妇梅毒检出率经统计学分析无著性差异(2=2.36,P=0.124;2=1.55,P=2.14)。结论:梅毒筛查应列为妊娠期常规筛查项目。同时应积极广泛开展宣传教育工作,加强孕产妇自我保健意识,最大限度地避免梅毒婴儿的出生。     

恩纳乳膏表面麻醉在CO2激光治疗尖锐湿疣和汗管瘤中的应用

目的:探讨恩纳乳膏表面麻醉在CO2激光治疗尖锐湿疣、汗管瘤的麻醉效果及不良反应.方法:在307例尖锐湿疣患者中,188例恩纳乳膏涂抹表面麻醉,119例1%利多卡因注射局部麻醉.在47例汗管瘤患者中,36例恩纳乳膏涂抹表面麻醉,11例1%利多卡因注射局部麻醉.比较各组麻醉效果及副反应,并将结果进行统计学分析.结果:恩纳组和利多卡因组患者治疗效果均无显著差异(P=0.867,P=0.583),恩纳组伤口渗液明显少于利多卡因组(P=0.024,P=0.03).伤口愈合明显好于利多卡因组(P＜0.01,P＜0.05).结论:恩纳乳膏应用于CO2激光治疗尖锐湿疣、汗管瘤患者有效而且安全.     

蓝科肤宁联合老鹤草治疗糖皮质激素依赖性皮炎疗效观察

目的观察老鹤草乳膏联合蓝科肤宁湿敷液用于糖皮质激素依赖性皮炎的临床疗效。方法按照随机数字表法,将90例糖皮质激素依赖性皮炎患者对半分为观察组和对照组。观察组45例,患处使用蓝科肤宁湿敷液湿敷,(20~30)min/次,2次/d,另每晚睡前局部涂抹老鹤草乳膏,2周后改为仅局部涂抹老鹤草乳膏,早晚各1次;对照组45例,患处使用蓝科肤宁湿敷液湿敷,(20~30)min/次,2次/d,另每晚睡前局部涂抹他克莫司软膏,2周后改为仅局部涂抹他克莫司软膏,早晚各1次。两组的疗程均为4周,疗程结束后随访4周观察评价疗效。结果观察组有效37例(82.2%),对照组有效34例(75.6%),经统计学处理,两组有效率比较差异无统计学意义(χ2=0.60,P0.05)。结论老鹤草乳膏联合蓝科肤宁湿敷液治疗糖皮质激素依赖性皮炎疗效肯定,耐受性好,无不良反应,值得临床选用。     

探讨压疮患者的临床护理方法及效果观察1张芬

目的 探讨基础护理联合云南白药治疗压疮的护理方法及效果。方法 将在我院住院治疗的128例(292处压疮)压疮患者随机分为实验组和常规组,各64例,两组患者都进行常规护理清创,常规组使用0.5%碘伏进行外敷并联合微波治疗仪设备配合治疗,实验组在使用0.5%碘伏外敷联合云南白药治疗,对比两组效果。结果 实验组在愈合时长、换药频度、愈合效果等方面均优于常规组,两组数据差异显著(P0.05)。结论 治疗压疮在常规护理的基础上外敷云南白药有如下特点,操作简单快捷,愈合时间明显缩短,压疮治愈率大大提高,临床效果明显,值得推广应用。     

探讨压疮患者的临床护理方法及效果观察

目的探讨基础护理联合云南白药治疗压疮的护理方法及效果。方法将在我院住院治疗的128例(292处压疮)压疮患者随机分为实验组和常规组,各64例,两组患者都进行常规护理清创,常规组使用0.5%碘伏进行外敷并联合微波治疗仪设备配合治疗,实验组在使用0.5%碘伏外敷联合云南白药治疗,对比两组效果。结果实验组在愈合时长、换药频度、愈合效果等方面均优于常规组,两组数据差异显著(P0.05)。结论治疗压疮在常规护理的基础上外敷云南白药有如下特点,操作简单快捷,愈合时间明显缩短,压疮治愈率大大提高,临床效果明显,值得推广应用。     

0.5%碘伏溶液治疗带状疱疹感染皮损的疗效观察

目的:观察0.5%碘伏溶液湿敷治疗带状疱疹感染皮损的疗效。方法:将60例带状疱疹感染皮损住院患者随机分为观察组和对照组,观察组30例采用0.5%碘伏溶液湿敷治疗创面,对照组30例采用3%硼酸溶液湿敷治疗创面,均临床观察7天,记录两组患者感染皮损的糜烂面渗液、干燥结痂或痂皮脱落情况,判断疗效。结果:7天治疗后,观察组≥90%的糜烂面渗液不明显或已结痂干涸,效果明显优于对照组,差异有统计学意义(2=23.67,P0.05)。结论:0.5%碘伏溶液用于治疗带状疱疹并感染的皮损较传统方法3%硼酸溶液湿敷有较好的疗效。     

组织常驻记忆性T细胞与咪喹莫特诱导的银屑病样小鼠复发模型

目的探讨在咪喹莫特(IMQ)诱导的银屑病样小鼠模型中再次诱导是否可以模拟复发表型及组织常驻记忆性T细胞(T_(RM))的变化。方法将20只C57BL/6小鼠编号后随机等分为两组,每组10只。所有小鼠背部剃毛后,一组小鼠涂抹62.5 mg凡士林(vaseline),另一组小鼠涂抹62.5 mg的5%咪喹莫特乳膏,连续6 d。第6天处死每组小鼠中的5只小鼠(Vaseline组和IMQ组),第36天时两组剩余小鼠背部皮肤均再次涂62.5 mg咪喹莫特(Vaseline-IMQ组和IMQ-IMQ组),连续6 d后处死小鼠。每日记录小鼠背部皮损严重程度指数(PASI),取背部皮肤进行HE染色。取脾脏及皮肤获取单细胞悬液,进行流式细胞检测。结果在第6天处死时,IMQ组银屑病样皮损典型,PASI评分最高为(9.50±0.58)。在第42天处死时,再次诱导的IMQ-IMQ组PASI评分为(10.75±0.50),比单次诱导的IMQ组(P=0.03)和Vaseline-IMQ组(8.25±1.50,P0.0001) PASI评分高,且比单次诱导的银屑病样皮损出现更快且更重。IMQ-IMQ组病理切片表皮厚度为(85.68±32.83)μm,比IMQ组(59.34±19.33)μm和Vaseline-IMQ组(52.04±11.94)μm更厚,差异均有统计学意义(P0.000 1)。IMQ-IMQ组脾脏Th17细胞比例增高为(5.17±1.94)%,高于IMQ组(3.36±0.58)%(P=0.18)和Vaseline-IMQ组(1.87±1.69)%(P=0.006)。IMQ-IMQ组小鼠背部皮肤的CD8~+CD103~+T_(RM)比例为(5.29±2.25)%,显著高于IMQ组(0.63±0.18)%(P=0.000 1)和Vaseline-IMQ组(1.12±0.61)%(P=0.000 4)。结论咪喹莫特诱导的银屑病样小鼠模型在间隔1个月后再次诱导,银屑病样皮损更重、反应更快、表皮增厚更多,且存在更多的Th17细胞和CD8~+CD103~+T_(RM),有可能作为银屑病研究中的小鼠复发模型。     

自制防晒乳膏体外及豚鼠在体防晒性能的评价

目的 观察自制防晒乳膏的防晒指数SPF值和PFA值。 方法 体外法测定样品防晒指数：将样品以2 μl/cm2的剂量涂抹于仿生皮肤3M膜上,然后用防晒指数测定仪测定样品的防晒指数。豚鼠在体防晒指数的测定：白化豚鼠48只,随机分为8组,其中4组不涂防晒样品,4组分别涂布自制防晒乳膏和对照样品（某市售防晒制剂）,使用SUV-1000型日光紫外线模拟器模拟紫外线照射,测定样品防晒指数。结果 体外法检测自制防晒乳膏和某市售制剂的SPF值分别为32.26 ± 2.42和30.87 ± 2.57,PFA值分别是24.28 ± 2.44和17.53 ± 2.28,两种制剂SPF相比,t = 0.94,P ＞ 0.05（n = 5）;但自制防晒乳膏对UVA的防护效果优于某市售制剂,t = 4.52,P ＜ 0.01（n = 5）。豚鼠在体法检测自制防晒乳膏和某市售制剂的SPF值分别为30.39 ± 6.65和28.79 ± 7.36,PFA ＞ 8.91和 ＞ 8.93,两种制剂SPF值比较,t = 0.38,P ＞ 0.05（n = 12）。结论 自制防晒乳膏和某市售制剂相比,对紫外线的防护效果相当。     

供应室护士艾滋病等职业暴露原因分析与防护

目的研究供应室护士艾滋病等职业暴露的原因及防护对策。方法将我院2016年2月~2016年8月供应室工作中受到职业暴露伤害的护士随机选取90名,采用随机数字表法方式分为观察组(n=45)与对照组(n=45),观察组进行职业暴露防护培训,开展职业暴露防护教育课堂。对照组进行普通职业暴露指导干预。对两组供应室护士职业暴露的原因和防护知识进行比较。结果观察组供应室护士对职业暴露原因和相关知识的掌握程度明显优于对照组护士,分别为73.33%和46.66%,两组比较具有显著差异性(P0.05)。结论对供应室护士艾滋病等职业暴露危险因素,必须采取与之对应的防护措施,加强对护理人员的安全培训,降低供应室护士艾滋病等职业暴露的危险。     

康复新液联合改良换药治疗Ⅱ、Ⅲ期压疮效果评价

目的评价中西药结合联合改良换药治疗Ⅱ、Ⅲ期压疮的临床治疗效果。方法将40例压疮患者按入院时间先后分为对照组和观察组各20例。2组先用碘伏消毒及生理盐水清创后,对照组直接应用美皮康湿性敷料敷贴;观察组采用中西药结合(康复新液100 m L庆大霉素8万单位混合溶液)局部涂抹,待干后用改良换药方法(美皮康湿性敷料敷贴,透明敷料固定美皮康敷料4周)处理。分别观察2组治愈率、换药次数、愈合时间。结果观察组治愈率、换药次数、愈合时间与对照组相比差异有统计学意义(P0.01)。结论中西药结合联合改良换药方法可明显缩短Ⅱ、Ⅲ期压疮愈合时间,减少换药次数,提高治愈率,操作简便,减少护理工作量,减轻患者经济负担。     

经尿道前列腺等离子电切术联合内分泌治疗晚期前列腺癌合并膀胱出口梗阻的疗效

目的:探讨经尿道前列腺等离子电切术(PKRP)联合内分泌治疗晚期前列腺癌合并膀胱出口梗阻的疗效。方法:选择泌尿科就诊的晚期前列腺癌合并膀胱出口梗阻患者90例。采用随机数字表将90例患者分为联合组(45例)与对照组(45例)。联合组患者予以PKRP联合内分泌治疗,对照组患者予以单纯的内分泌治疗,疗效均为6个月。观察并比较治疗前和治疗6个月后最大尿流率(Q_(max))、残余尿量(RU)、血总前列腺特异性抗原(TPSA)、国际前列腺症状评分(IPSS)和生活质量指数评分(QOL)水平的变化。结果:两组患者治疗前QOL评分、Q_(max)、RU、IPSS评分和TPSA水平比较差异无统计学意义(P0.05)。治疗6个月后,两组患者QOL及Q_(max)均较前明显上升,RU、IPSS评分和TPSA水平较前明显减少(P0.05或P0.01),且联合组QOL评分、Q_(max)、RU、IPSS评分变化幅度较对照组更明显(P0.05),但治疗后两组TPSA水平差异无统计学意义(P0.05)。结论:PKRP联合内分泌治治疗晚期前列腺癌伴合并膀胱出口梗阻的患者的疗效明显优于单纯的内分泌治疗,能明显改善膀胱出口梗阻引起的排尿困难症状,提高最大尿流率,减少残余尿量,提高生活质量。     

调Q-Nd:YAG激光祛除文眼线时眼球保护方法比较

对调Q-Nd:YAG激光祛除文眼线时用手法和金属眼罩保护眼球两种方法比较,探索一种简单的保护眼球的方法。方法 40例患者随机分为两组,治疗组用手法保护眼球,即用手指使治疗部位的上(或下)睑缘轻微外翻,同时用其余手指使对应的下(或上)睑皮肤挤近治疗部位的上(或下)睑缘外翻的睑结膜处,以看不到眼球为止;对照组用金属眼罩保护眼球。结果对照组20例中19例(95.00%)患者认为眼内放金属眼罩比较痛苦,并且6例(30.00%)患者需要表面麻醉,术后2例(10.00%)患者患结膜炎。治疗组20例中均无需表面麻醉,术后也无结膜炎。结论激光祛除文眼线时用手法保护眼球方法操作简单,避免了眼内放金属眼罩引起的并发症,值得应用。     

不同方法应用吲哚美辛巴布膏治疗痛经的疗效研究

目的:观察比较经期应用吲哚美辛巴布膏于腰骶部及腹部耻骨联合上方治疗痛经的效果。方法:采用调查问卷,收集31例痛经女性的月经基本信息。第一次月经来临时,将吲哚美辛巴布膏敷贴在腰骶部;在第二次月经来临时,敷贴在腹部耻骨联合上方,均每天白天贴用12h,晚上取下,共3d。观察两次月经痛经缓解时间、痛经缓解程度、痛经持续天数,并进行前后对比,分析吲哚美辛巴布膏对缓解痛经的作用,以及敷贴位置的不同对缓解痛经的差异。结果:患者痛经NRS评分两次用药后均有减轻,差异有统计学意义(P=0.041及P=0.003)。第一次用药后痛经天数减少(2 vs.1.71d),差异无统计学意义(P=0.241);第二次月经用药后痛经天数减少(2 vs.1.65d),差异有统计学意义(P=0.000)。两次用药后痛经均有缓解,痛经缓解时间差异无统计学意义(12.74 vs.7.61h,P=0.231)。31例患者中26人(83.9%)需要服用止痛药物,第一次用药后只有17人(54.8%)需要口服止痛药物,前后相比,差异有统计学意义(P=0.014)。结论:吲哚美辛巴布膏对于治疗痛经有良好的疗效,敷贴于腹部耻骨联合上方比贴在腰骶部对于痛经治疗的效果可能更好。     

子宫输卵管超声造影中引起造影剂静脉逆流的相关因素研究

目的探讨子宫输卵管超声造影中引起造影剂静脉逆流现象发生的相关因素。方法回顾性分析2018年7月至2019年7月广东省信宜市人民医院接诊并行子宫输卵管超声造影的50例不孕症患者,根据接受造影检查距月经干净的时间分为3~4天组(n=13)、5~6天组(n=21)和7天组(n=16);根据接受造影检查时患者子宫内膜厚度分为≤6mm组(n=11)、7~8mm组(n=22)和≥9mm组(n=17)。比较检查时间与子宫内膜厚度对造影剂静脉逆流的影响。结果5~6天组造影剂逆流率略高于3~4天组、7天组,但差异无统计学意义(χ²=0.024,P=0.877;χ²=0.018,P=0.893);≤6mm组造影剂逆流率高于7~8mm组、≥9mm组(χ²=0.052,P=0.028;χ²=0.053,P=0.042),7~8mm组造影剂逆流率与≥9mm组比较,差异无统计学意义(χ²=1.000,P=0.623)。结论子宫输卵管超声造影剂静脉逆流发生率与子宫内膜厚度具有相关性,建议进行子宫输卵管超声造影时在子宫内膜厚度≥7mm时进行,有助于降低造影剂静脉逆流发生率。     

A retrospective observational study of primary cutaneous malignant melanoma patients treated with excision only compared with excision biopsy followed by wider local excision

BACKGROUND: For primary cutaneous malignant melanoma the guidelines recommend an excision biopsy of the suspected lesion followed by wider local excision; the diagnosis can then be confirmed and excision margins planned. OBJECTIVES: To compare retrospectively the clinicopathological features, surgical margins and survival of patients from the Scottish Melanoma Group database whose tumour was removed by excision only (one-stage) or excision biopsy followed by wider local excision (two-stage) surgery. METHODS: The Scottish Melanoma Group database records the clinicopathological features, surgical treatment and follow-up information of all patients with malignant melanoma in Scotland. From this 1595 patients were identified over a 19-year interval from 1979 to 1997 with follow-up until the end of December 1999. Overall survival, disease-free survival and recurrence-free interval were examined with univariate and multivariate statistical methods. RESULTS: The patients in the one-stage excision group (n = 547) were statistically significantly older (P < 0.001), had thicker melanomas (P < 0.001), a higher proportion of lentigo maligna melanomas (P < 0.001), head and neck (P < 0.001), and ulcerated lesions (P < 0.003) compared with the two-stage group (n = 1048). The margins of excision were significantly narrower in the one-stage compared with the two-stage group (P < 1 x 10(-5)). Fifty-two percent of all one-stage excisions were performed with a margin < 1 cm compared with 20% of the two-stage group. The excision margin was more positively correlated with the Breslow thickness for the two-stage over the one-stage group (Spearman rho = 0.38, P < 0.001; and 0.27, P < 0.001, respectively). Overall survival (OS), disease-free survival (DFS), and recurrence-free survival (RF) were all statistically significantly better in the two-stage compared with the one-stage excision group, P < 1 x 10(-5), P < 1 x 10(-5) and P = 0.001, respectively (log rank test). After adjusting for the prognostic factors of age, sex, tumour thickness, site, histology and ulceration, OS, DFS and RF were still significantly better in the two-stage compared with the one-stage group [hazard ratio (HR) 0.75, 95% confidence interval (CI) 0.61-0.92, P = 0.006; HR 0.75, CI 0.62-0.90, P = 0.002; and HR 0.78, CI 0.62-0.99, P = 0.04, respectively]. CONCLUSIONS: This study showed that one-stage excisions were more common in patients with poorer prognostic features and that excision with margins narrower than those suggested by current guidelines was more likely. Patient survival was statistically significantly better with the two-stage procedure, although the reasons for this were unclear.     

Different therapeutic modalities for treatment of melasma

Background Chemical peels and topical depigmenting agents have become a popular modality in the treatment of melasma. Aims To compare the clinical efficacy of trichloroacetic acid peel 20%vs. Jessner’s solution peel vs. the topical mixture of hydroquinone 2% and kojic acid. Patients and methods Forty five patients with melasma were randomly assigned into three groups of fifteen patients each. Group A received Jessner’s solution peel, group B received trichloroacetic acid peel 20%, and group C received topical hydroquinone 2% and kojic acid. All patients were seen in follow‐up period after 16 weeks; clinical evaluation using Melasma Area and Severity Index (MASI) score and photography were recorded before and after treatment and after 16 weeks. Results There was a decrease in MASI score in all three groups after treatment and after follow‐up period but after treatment MASI score was statistically significantly lower in group A than group C (P = 0.01), and it was also statistically significantly lower in group B than group C (P < 0.001) but there was no statistically significant difference between groups A and B. After the follow‐up period, MASI score was statistically significantly lower in group A than group C (P < 0.001), statistically significantly lower in group B than group C (P < 0.001), and statistically significantly lower in group B than group A (P = 0.035). The statistical analysis was done through one‐way anova followed by least significant difference (LSD). Conclusion Trichloroacetic acid 20% showed better results than Jessner’s solution as peeling agent and hydroquinone 2% with kojic acid as a topical agent in the treatment of melasma.     

宫腔镜联合自凝刀射频消融子宫内膜治疗围绝经期功能性子宫异常出血的临床疗效分析

目的探讨宫腔镜联合自凝刀射频消融子宫内膜治疗围绝经期子宫功能性异常出血的临床疗效。方法选取2015年2月至2017年2月广东药科大学附属第三医院妇科诊治的81例围绝经期子宫功能性异常出血患者作为研究对象。随机分为观察组与对照组,其中观察组41例,对照组40例。观察组采用宫腔镜联合自凝刀射频消融子宫内膜治疗,对照组在超声引导下采用自凝刀射频消融子宫内膜治疗。观察比较两组患者的有效率、子宫内膜厚度以及Kupperman评分、血清卵泡生成激素(FSH)、黄体生成素(LH)、雌二醇(E2)水平变化情况等。结果观察组平均手术时间、术中出血量同对照组比较,差异无统计学意义(P>0.05);观察组闭经率(65.85%)高于对照组闭经率(42.50%),差异具有统计学意义(χ~2=13.252,P=0.018),观察组总有效率(95.12%)与对照组总有效率(95.00%)比较,差异无统计学意义(χ~2=4.386,P=0.221),但秩和检验,差异无统计学意义(χ~2=4.386,P=0.221);观察组子宫内膜厚度及Kupperman评分与对照组相比,差异具有统计学意义(P<0.05);观察组血清FSH、E2、LH水平较对照组降低更为显著,差异具有统计学意义(P<0.05)。结论采用宫腔镜联合自凝刀消融子宫内膜手术,治疗围绝经期功能性子宫异常出血具有安全有效,可保留患者子宫,能显著提升患者疗效,更为彻底地消融子宫内膜,改善患者更年期综合征,降低血清激素水平,改善患者血清激素紊乱。     

A comparison of three times vs. five times weekly narrowband ultraviolet B phototherapy for the treatment of chronic plaque psoriasis

Background: Narrowband ultraviolet B (NB-UVB) phototherapy is an effective treatment for psoriasis.
Objectives: To compare the effects of three and five times weekly NB-UVB phototherapy in the treatment of chronic plaque psoriasis.
Methods: Sixty-five patients with chronic plaque psoriasis were allocated to receive three or five times weekly NB-UVB, starting at low dose.
Results: Among the patients who completed the study, clearance was achieved in 18 out of 23 patients (78%) in the three times weekly group and in 15 out of 22 patients (68%) in the five times weekly group. The difference was not statistically significant ( P =0.44).
No statistically significant differences were found between the two groups in the number of treatments ( P =0.95), cumulative UVB dose ( P =0.51), and rate of side-effects. Length of the treatment period was significantly shorter in the five times weekly group ( P <0.001). At the end of treatment, the mean psoriasis area and severity index score was lower in the three times weekly group ( P =0.02).
Conclusions: We recommend three times weekly NB-UVB for chronic plaque psoriasis; however, the more rapid clearance of psoriasis with five times weekly phototherapy may justify using this method in some patients.     

麝香配伍乳香对慢性前列腺炎模型大鼠脊髓L5-S2段背角P物质表达水平的影响

目的探讨麝香配伍乳香对慢性前列腺炎(CP)模型大鼠脊髓L5-S2段背角的P物质(SP)的作用。方法48只雄性SD大鼠随机分为空白对照组(n=8)、模型对照组(n=8)和治疗组(n=32),治疗组又为麝香-乳香低剂量组(n=8)、麝香-乳香中剂量组(n=8)、麝香-乳香高剂量组(n=8)、麝香-乳香-虎杖组(n=8)。空白对照组不予造模,其余5组建立模型。治疗组采用不同组方及剂量治疗,空白对照组和模型对照组采用生理盐水予以灌胃。测定并比较各组治疗前后的抬腿反应阈值(PWT)和SP免疫阳性反应的平均光密度值(OD)。结果与空白对照组比较,造模后大鼠PWT均明显下降,差异具有统计学意义(P<0.05);与模型对照组比较,含麝香、乳香的治疗组大鼠PWT均较高,差异具有统计学意义(P<0.05);各治疗组间比较,差异均无统计学意义(P>0.05)。与空白对照组比较,模型对照组SP表达水平明显较高,差异具有统计学意义(P<0.05)。与模型对照组比较,治疗组SP表达均下降,差异具有统计学意义(P<0.05)。在各治疗组中,麝香-乳香-虎杖治疗组SP的OD值下降最明显,与其他治疗组比较,差异具有统计学意义(P<0.05)。不同剂量的麝香-乳香治疗组间SP的OD值比较,差异无统计学意义(P>0.05)。结论造模后的CP模型大鼠的痛阈降低,其L5-S2脊髓节段中SP表达明显升高。含麝香、乳香的治疗组大鼠SP表达明显降低,同时疼痛敏感性下降。表明麝香配伍乳香可以通过调节SP在传递疼痛上的效能减轻大鼠CP疼痛。